| 1985–88: HIV begins to enter China |
During this phase, China’s epidemic was at a very low level, with very few cases reported through the public health system and HIV prevalence not exceeding 1% in any defined subpopulation. By 1988, a total of seven provinces, municipalities and regions had reported 22 HIV/AIDS cases; most of them were foreigners or Chinese residents returning from overseas. |
The Chinese government responded with policies aimed at stopping HIV from entering China. Some of the measures taken included:
case identification in major cities and customs border checkpoints.4 a ban on importing blood products issued in 1984.5 in 1986, HIV/AIDS became a notifiable disease.6
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| 1989–94: rapid HIV transmission among groups at highest risk |
During this phase, HIV began to spread among high-risk groups. In 1989, an outbreak of HIV was detected among injecting drug users (IDUs) in Yunnan province along China’s border with Myanmar, and subsequent investigations revealed that the epidemic had spread among IDUs in neighbouring cities and counties.7,8 By 1994, HIV/AIDS cases had been reported in 22 provinces, autonomous regions and municipalities. |
China’s response to HIV/AIDS was primarily a policing approach that relied on crackdowns against prostitution and drug use to combat the spread of HIV. At the same time, China’s Ministry of Health began to discuss implementing behavioural interventions in high-risk populations, including providing standardized sexually transmitted infection (STI) testing and treatment for sex workers and their clients during police crackdowns on prostitution.9
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| 1995–2002: HIV spreads throughout the country |
Between 1995 and 2002, HIV spread rapidly and the epidemic became concentrated in high-risk groups.10 In the mid-1990s, an outbreak of HIV transmission among paid plasma donors in several east-central provinces in China was confirmed.11–13 By 1998, all 31 provinces/autonomous regions/municipalities in China had reported HIV/AIDS cases. |
Senior government officials in China gradually came to understand the seriousness of the HIV epidemic and the urgency of the response needed. A series of policies and actions were taken at different levels, including:
issuance of a national Blood Donation Law that took effect in 1998 to address unsafe blood collection practices; establishment of a national HIV/AIDS surveillance system; in 1996, the State Council STD/AIDS Prevention and Control Coordinating Meeting Mechanism was established to strengthen cooperation between government agencies; in 1998, the Ministry of Health created the National Center for STD/AIDS Control and Prevention to provide technical guidance for HIV/AIDS prevention and control across the country; in 1998, the ‘China Medium and Long Term Plan for HIV/AIDS Prevention and Control (1998–2010)’ was enacted, in which condom promotion was addressed and encouraged as a measure for preventing sexual transmission.14 To ensure that overlapping agencies understood their roles and responsibilities in combating the HIV epidemic, a ‘Duty of related ministries (civil organizations) on HIV/STD control and prevention’ was issued in 2000 and action plans on HIV/STD control and prevention were developed by each relevant ministries;15 and in 2001, the first 5-year action plan for the containment and control of HIV/AIDS (2001–05) was issued.16
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| 2003–present: the number of AIDS cases continues to rise |
During this phase, the epidemic has remained concentrated in high-risk groups, with some localities meeting the definition of generalized transmission (HIV prevalence >1% among pregnant women). More and more people living with HIV began to progress to clinical AIDS. |
After the Severe Acute Respiratory Syndrome outbreak in 2003, government support for public health efforts increased dramatically. The HIV response was strengthened by an influx of new funds and high-level political support. Policies and measures developed during this period have included:
issuance of the ‘Four Frees and One Care’ policy to increase access to HIV testing and clinical care services;17,18 issuance of the ‘Regulations on HIV/AIDS Prevention and Treatment’ in early 2006 to create an enabling legal environment for the HIV response;19 issuance of China’s second action plan for the containment and control of HIV/AIDS (2006–10);20 scaling-up of HIV testing: between 2004 and 2005, the Ministries of Health, Public Security and Justice launched HIV screening services among former plasma donors and among inmates incarcerated in compulsory detoxification centres and other custodial settings.21,22 As a result, an additional number of HIV infected cases were found; the establishment and rapid expansion of methadone maintenance treatment (MMT) and needle exchange programmes. By the end of 2009, a total of 680 MMT clinics were set up in 27 provinces/autonomous regions/municipalities. A cumulative total of 241 975 heroin addicts received MMT, with a retention rate of 65.6%. MMT clinics provide free regular HIV and hepatitis C virus testing and counselling services. Needle and syringe social marketing and exchanges were gradually expanded; localizing the production of AIDS-related medications and promoting anti-retroviral therapy (ART): In 2002, the Ministry of Health, Ministry of Finance, State Taxation Administration, and General Customs Administration jointly obtained the approval of the State Council for a 5-year tariff-free import of AIDS-related medications. In 2003, the Food and Drug Administration approved the production of four anti-retroviral drugs by two domestic pharmaceutical manufacturers. The cost of anti-retroviral drugs was reduced to 3500–4000 Chinese yuan per patient per year, significantly increasing the accessibility of ART; and paediatric ART was launched in 2005. By the end of 2009, a cumulative total of 79 946 adults and 1793 children received ART in 1821 counties across China.23
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